Racial disparities in outcomes after cancer surgery are becoming increasingly apparent. Black patients have both increased risks of operative mortality and lower 5-year survival rates. This project will pursue the Hypothesis that these disparities primarily reflect the suboptimal health care systems in which black patients tend to receive their care. In exploring hospital-level differences in quality of care, we have 3 specific aims: Aim I. To explore racial disparities in the structure and process of care with cancer surgery - Using both national Medicare database (2000-4) and linked SEER-Medicare files (1995-2004), we plan to study structure and process of care variables potentially related to both race and surgical quality in patients with lung, breast, and colorectal cancer. Aim II. To identify which factors help explain racial disparities in surgical outcomes - Using hierarchical models, we will assess the extent to which racial disparities in surgical outcomes are explained by differences in specific structural factors and processes of care (from Aim 1). Aim III. To delve deeper into structure and process with clinical data - To add clinical "granularity" to our research, we will repeat Aims 1 and 2 using prospective clinical data from the Michigan Surgical Quality Collaborative, which involves 17 of the largest hospitals in Michigan (including several with predominantly minority populations). This project will serve as a platform for mentoring several surgeon scientists interested in quality of care issues and racial disparities in bladder, breast, colorectal, and other cancers. With mentored research opportunities and further instruction in health services research, these junior investigators will acquire the skills necessary to develop clinically-oriented research agendas exploring quality of care problems in their fields. They will also acquire insights necessary to develop and evaluate interventions aimed at reducing racial disparities.